Thumb Sucking

Thumb sucking is a normal behavior in early infancy whose incidence peaks at 18 to 21 months of age. It is generally viewed as a biologic drive that develops into a habit. It typically resolves by 4 years of age, but it can persist much longer. Problems associated with thumb sucking depend on the habit's duration, intensity, and frequency and can include malocclusion; paronychia; infection; digital hyperextension, soreness, and callous formation; accidental poisoning; and psychosocial issues. Many parents do not approve of the behavior and some will criticize, ridicule, or punish thumb suckers. Children who suck their thumbs often are viewed as less fun, happy, likable, attractive, intelligent, and desirable as friends or classmates.

Thumb sucking treatment may be considered when any of the problems listed previously affect the child's physical or psychosocial well-being. Treatment is not considered necessary before 4 to 6 years of age. Options include orthodontic appliances, physical barriers, aversive taste treatments, and when appropriate, psychological counseling. Orthodontic appliances, although effective, are very expensive. Physical barriers, such as mittens or socks, have variable rates of success. Topical aversive therapies (special nail polishes) may work, but only with the child's approval. Thumb sucking and other chronic habits may be markers for anxiety or stress that might require an evaluation of the child's and family's psychosocial functioning. Most thumb sucking in childhood is harmless and self-limited and does not require directed intervention.

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